An unusual finding of tumorlet carcinoid and endobronchial hamartoma in the lobar bronchus / Hallazgo inusual de tumorlet carcinoide y hamartoma endobronquial en el bronquio lobar

SUMMARY: Neuroendocrine lung tumours are a group of different tumours that have similar morphological, immunohistochemical and molecular characteristics, and represents 1-2 % of all malignant lung tumours. Tumorlet carcinoids represent the nodular proliferation of hyperplastic neuroendocrine cells that is smaller than 5 mm in size. In this study, we reported the unusual finding of tumour carcinoid and endobronchial hamartoma in the same bronchus. A 49-year-old male patient with symptoms of prolonged severe cough and fever, and was treated for pneumonia. Since he did not adequately respond to antibiotic therapy lung CT scan was performed which showed middle lobe bronchus obstruction. Bronchoscopy revealed a lobulated whitish tumour which was biopsied and histopathological diagnosis was hamartoma. Tumour could not be completely removed during bronchoscopy, it was decided to surgically remove it. On serial section, during gross examination in the same bronchus, an oval yellowish area with a diameter of 3 mm was found along the bronchial wall. According to gross and histomorphological characteristics and immunophenotype of tumour cells, the diagnosis of tumour carcinoid was set. Diagnosis of carcinoids of the tumorlet type is usually an accidental finding and it can be seen on CT in the form of subcentimeter, single or multiple, nodular changes. Considering that the clinical picture is nonspecific, they should always be kept in mind as a possible differential diagnosis.

RESUMEN: Los tumores neuroendocrinos de pulmón son un grupo de tumores de diferentes características morfológicas, inmunohistoquímicas y moleculares similares, y representan el 1- 2 % de todos los tumores malignos de pulmón. Los carcinoides tumorales representan la proliferación nodular de células neuroendocrinas hiperplásicas de tamaño inferior a 5 mm. En este estudio reportamos el hallazgo inusual de tumor carcinoide y hamartoma endobronquial en el mismo bronquio. Un paciente varón de 49 años con síntomas de tos severa prolongada y fiebre fue tratado por neumonía. Al no responder adecuadamente a la terapia con antibióticos, se realizó una tomografía computarizada de pulmón que mostró obstrucción del bronquio del lóbulo medio. La broncoscopia reveló una tumoración blanquecina lobulada de la cual se tomó biopsia y el diagnóstico histopatológico fue hamartoma. No fue posible extirpar el tumor por completo durante la broncoscopia y se decidió extirparlo quirúrgicamente. En la sección seriada, durante el examen macroscópico en el mismo bronquio, se encontró un área amarillenta ovalada de 3 mm de diámetro a lo largo de la pared bronquial. De acuerdo a las características macroscópicas e histomorfológicas y de inmunofenotipo de las células tumorales, se estableció el diagnóstico de tumor carcinoide. El diagnóstico de carcinoides de tipo tumorlet suele ser un hallazgo accidental y se observan en la TC en forma de cambios nodulares subcentimétricos, únicos o múltiples. En consideración de que el cuadro clínico es inespecífico, siempre debe tenerse en cuenta como posible diagnóstico diferencial.

Compromiso tumoral de vía aérea en pediatría / Pediatric airway compromise by tumors

Los tumores traqueo bronquiales son extremadamente infrecuentes en la edad pediátrica e incluyen lesiones benignas y malignas. Por la baja frecuencia en niños y sintomatología respiratoria inespecífica, la sospecha diagnostica es habitualmente tardía. El tratamiento de elección en la mayoría de ellos es la resección quirúrgica abierta, sin embargo, la remoción endoscopia podría estar indicada es casos muy seleccionados con histología benigna y de localización accesible.

Tracheobronchial tumors are extremely rare in children and include benign and malignant lesions. Due to the low frequency in children and nonspecific respiratory symptoms, diagnostic suspicion is usually late. The treatment of choice in most of them is open surgical resection, however, endoscopy removal could be indicated in highly selected cases with benign histology and accessible location.

Carcinoma mucoepidermoide bronquial: a propósito de dos casos clínicos / Bronchopulmonary mucoepidermoid carcinoma: apropos of two clinical cases

Resumen El carcinoma mucoepidermoide bronquial es una neoplasia infrecuente, representando el 0,1 a 0,2% de los tumores malignos primarios del pulmón. En general tiene un buen pronóstico, sin embargo, existe un subtipo de alto grado de pronóstico más ominoso. En este artículo se presentan dos casos clínicos de carcinoma mucoepidermoide bronquial de bajo grado, enfocado en su diagnóstico y manejo quirúrgico.

ABSTRACT Bronchopulmonary mucoepidermoid carcinoma is an uncommon neoplasm, accounting for 0.1 to 0.2% of primary malignant tumors of the lung. In general it has a good prognosis, however there is a subtype of high grade of more ominous prognosis. In this paper we present two clinical cases of low grade pulmonary mucoepidermoid carcinoma, focused on their diagnosis and surgical management.

Carcinoma mucoepidermoide bronquial en la infancia: Caso clínico / Bronchial mucoepidermoid carcinoma in childhood: Case report

Los tumores bronquiales son raros en los niños. La mayoría son malignos; el más común es el tumor carcinoide. Con menor frecuencia, se asienta en el árbol traqueobronquial el carcinoma mucoepidermoide. El carcinoma mucoepidermoide representa del 0,1% al 0,2% de los tumores malignos broncopulmonares. Se manifiesta con síntomas de obstrucción de la vía aérea y/o neumonías recurrentes. El diagnóstico precoz y el tratamiento adecuado son de gran importancia en el pronóstico. La broncoscopía con biopsia de la masa endobronquial es el método de elección para confirmar el diagnóstico. El tratamiento consiste en la resección quirúrgica de la lesión. Se presenta a una niña de 11 años con disnea de esfuerzo y tos debidas a un carcinoma mucoepidermoide bronquial de bajo grado de malignidad. Se describen las manifestaciones clínicas, los métodos diagnósticos y el tratamiento de esta rara neoplasia en pediatría.

Bronchial tumors are rare in children. Most of them are malignant, being the carcinoid tumor the most common. Less frequently the mucoepidermoid carcinoma is found in the tracheobronchial tree. Mucoepidermoid carcinoma accounts for 0.1 to 0.2% of all malignant bronchopulmonary tumors. It manifests with symptoms of airway obstruction and/or recurrent pneumonias. Early diagnosis and appropriate treatment are of great importance in the prognosis. Bronchoscopy with biopsy of the endobronchial mass is the method of choice to confirm the diagnosis. Treatment consists of surgical resection of the lesion. We present an 11-year-old girl with dyspnea on exertion and cough due to a low malignant mucoepidermoid carcinoma of the bronchi. We describe the clinical manifestations, the diagnostic methods and the treatment of this rare neoplasia in pediatrics.

Endobronchial solitary fibrous tumor

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that appears primarily in the pleura and rarely in intrapulmonary or endobronchial topography. The authors report the case of a 47-year-old woman who presented obstructive respiratory symptoms for 4 years. The chest computed tomography and bronchoscopy showed an obstructive polypoid lesion located between the trachea and the left main bronchus associated with distal atelectasis of the left lung. A resection of the lesion was performed and, macroscopically, the mass was oval, encapsulated, and firm, measuring 2.3 × 1.7 × 1.5 cm. Histology revealed low-grade mesenchymal spindle cell neoplasm, with alternating cellularity, myxoid areas, and mature adipose tissue outbreaks, as well as blood vessels with irregular walls. The immunohistochemical study was positive for CD34, CD99, and BCL2. The diagnosis was SFT in an unusual topography. The patient's symptoms remitted after tumor excision, and no systemic problems were evident. SFTs primarily affect adults and often follow a benign course; however, their behavior is unpredictable. The presence of necrosis and mitotic activity may portend a poor prognosis. Endobronchial SFTs are rare but should be evaluated and monitored similar to SFTs at other sites, with a long-term follow-up

Endobronchial carcinoid tumor in a 15 years old patient

Endobronchial carcinoid tumor is an extremely rare neoplasm in children and adolescence. Herein, a case of endobronchial carcinoid tumor in a 15 year old female presented with recurrent chest infection for a long time and after a careful examination and investigation, the case was diagnosed.

Spectrum of intrabronchial mass lesions and role of flexible bronchoscopy in their diagnosis: A series of 74 cases.

Background. Variety of benign and malignant lesions of respiratory system presents as intrabronchial mass lesions. Present study was carried out to study the spectrum of intrabronchial lesions and role of flexible flexible bronchoscopy in their diagnosis. Methods. Retrospective study of case-records of patients with intrabronchial mass lesions diagnosed by flexible bronchoscopy, bronchial washings and bronchial biopsy between January 2004 and June 2006. Results. Out of the 696 flexible bronchoscopies done during the study period, intrabronchial mass lesions were evident in 74 patients (10.6%) (age range 21-86 years; 60 males). Fifty (68%) lesions were malignant, eighteen (24%) lesions were benign while six (8%) lesions were inconclusive. Diagnostic yield was about 92%; repeat bronchoscopy for inconclusive results improved the diagnostic yield. Conclusions. Though malignant lesions are common, benign lesions remain important causes of intrabronchial mass lesions. Bronchoscopy with adequate sampling is an essential diagnostic modality for confirming the diagnosis of such lesions.

A 12-year-old girl with hodgkin’s disease presenting as a non-resolving pneumonia and an endobronchial nodule.

The presence of a non-resolving pneumonia warrants the suspicion of a possible malignancy. While pulmonary involvement in Hodgkin’s disease can present as a non-resolving pneumonia, the clinical clues of dyspnoea, stridor and wheeze point to a possible endobronchial involvement. A bronchoscopy in such a situation can be valuable for diagnosis, and can aid in staging of the disease. The true incidence of endobronchial involvement in Hodgkin’s disease is not known, but when diagnosed early and treated appropriately, the prognosis is usually good, and a complete cure is possible.

Endobronchial Non-Hodgkin’s Lymphoma presenting as mass lesion.

A 40-year-old male presented with clinical and radiological manifestations of right lung atelectasis and post-obstructive pneumonia. Flexible bronchoscopy revealed gross narrowing of the right upper lobe bronchus and a smooth, white endobronchial mass completely occluding the right lower lobe bronchus. Endobronchial biopsy from the mass lesion yielded low grade B-cell non-Hodgkin’s lymphoma. This is one of the rarest presentation of non-Hodgkin’s lymphoma.

Endobronchial leiomyoma: an unusual non-defining neoplasm in a patient with AIDS / Leiomioma endobronquial: rara neoplasia não definida em paciente com AIDS

Smooth muscle neoplasms are more frequent in human immunodeficiency infected children than in HIV seropositive adults. Endobronchial leiomyoma is a rare benign tumor in HIV infected adult patients. Epstein-Barr virus (EBV) has been implicated in the pathogenesis of these tumors. Here we describe an adult patient with HIV infection with atelectasis of the left upper pulmonary lobe as the first clinical expression of an intrabronchial leiomyoma. In this case, we can not show the association with EBV. Our report suggests that smooth muscle tumors as leiomyoma should be included in the differential diagnosis of endobronchial masses in AIDS patients.

Neoplasmas da musculatura lisa são mais freqüentes em crianças infectadas pelo vírus da imunodeficiência humana do que em adultos HIV-soropositivos. Leiomioma endobronquial é um tumor benigno em pacientes adultos infectados por HIV. Vírus Epstein-Barr (EBV) tem sido implicado na patogenia destes tumores. Descrevemos paciente adulto infectado pelo HIV com atelectasia do lobo pulmonar superior esquerdo como primeira manifestação clínica de leiomioma intrabronquial. Neste caso não pudemos demonstrar a associação com EBV. Nosso relato sugere que tumores de musculatura lisa como leiomioma deveriam ser incluídos no diagnóstico diferencial de massas endobronquiais em pacientes com AIDS.

[Endobronchial non Hodkin's lymphoma associated to tuberculosis about one case]

The tuberculosis is an infectious disease among the most spread in the world. This pathology might occur at any stage of state of immunodepression. The association of the tuberculosis to endobronchial non-Hodgkin's lymphoma is exceptional. We report an observation of a 27 year old female patient presenting a chronic cough evolving during one year with occurrence of two episodes of haemoptysis. The bronchial endoscopy demonstrated whitish granulations and the anatomicopathological study showed an endobronchial non-Hodgkin's lymphoma. The culture of the bronchial fibro-aspiration liquid showed mycobacterium tuberculosis Therefore diagnosis of the endobronchial non Hodgkin s lymphoma and of tuberculosis were retained In conclusion the association of the tuberculosis to the endobronchial non-Hodgkin's lymphoma has to be suggested however it is exceptional The common clinical symptomatology of both pathologies might hide the other and therefore delay the diagnosis of one of both pathologies The bronchoscopy is essential in the diagnosis of both pathologies who have completely different treatments

Isolated oesophageal cyst connected with the bronchus

We report an unusual case of a patient with an oesophageal cyst connected to the bronchus. A 24-year old male with a two-year history of repeated attacks of chest infection and haemoptysis was found to have a cyst of 4 x 4 cm affecting the anterior and apical segments of the right upper lobe. The cyst was excised in its entirety and the histopathological study of the cyst showed stratified squamous epithelium with submucosal and muscular layer but no cartilage. The pathological diagnosis was an oesophageal cyst. No previous case of isolated oesophageal cyst connected to the bronchus has been reported according to the available literature.

Surgical management of endobronchial tumors: analysis of 24 patients

To evaluate the variable surgical options performed in the management of endobronchial tumors and the factors determining selection of the appropriate surgical technique. Retrospective study of a series of 24 patients with endobronchial tumors who were diagnosed and underwent surgery in the cardiothoracic surgery department, Mansoura university hospital from January 1985 to March 2006. Full history taking and complete clinical examination, routine laboratory investigations, chest x-ray, and computerized tomography, and bronchoscope were done for all cases. Surgery was the line of treatment for all patients. Close sex distribution with age ranges from 20-64 years. Cough with expectoration was the main presentation. Zonal opacity was the most common radiological finding. CT chest showed sensitivity of 79.2% for detection of endobronchial lesions. Bronchoscopic examination revealed endobronchial lesions in all patients. Benign tumors were detected in 5 patients and malignant lesions in 19 patients, 14 patients were neuroendocrine tumors and 5 patients were other malignant varieties. Surgical interference included bilobectomy [7 patients], lobectomy [5 patients] pneumonectomy [7 patients], and one patient underwent surgical exploration for open biopsy while 4 bronchoplastic procedure were performed. Endobronchial tumors occur over a wide range of age without significant sex differentiation. Endobronchial tumor should be suspected in case of prolonged chest complaint inspite of maximal medical treatment. Bronchoscope is the main diagnostic tool and is important for detection of the provisional plane for surgery. Early diagnosis and screening should be established for early detection of endobronchial tumors and more conservative resectional and bronchoplastic techniques

ThE Role of Endoscopic Surgery for Completely Obstructive Endobronchial Benign Tumor

BACKGROUND: The improving techniques of therapeutic bronchoscopy have been replacing conventional surgery for resecting endobronchial benign tumor. However, there could be some limitation for performing bronchoscopic intervention for the patients with complete bronchial obstruction. To evaluate the role of endoscopic surgery for completely obstructive endobronchial benign tumor, we retrospectively reviewed the medical records of 7 patients who underwent bronchoscopic resection due to completely obstructive benign tumor. METHODS: Rigid bronchoscopy was performed under general anesthesia. After the stalk of tumor was identified with using a 1 mm biopsy forceps as a probe, a Nd-YAG laser was used to coagulate the stalk of tumor. The tumor was then removed. RESULTS: Bronchoscopic resection was successful in 6 out of 7 patients. The histological diagnoses were 3 leiomyomas, 3 harmatomas and 1 lipoma. There was no mortality in our study. Pneumomediastinum developed in 1 patient, and this patient was treated with 3 days of oxygen therapy. In 5 out of the 6 successful patients, there was no recurrence for a median of 35 months. In 1 patient, leiomyoma recurred after 17 months, and this was treated by pneumonectomy. CONCLUSIONS: Endoscopic surgery could be applied to the patients with completely obstructive endobronchial benign tumor.

Detection of Pre-invasive Endobronchial Tumors with D-light/Autofluorescence System

Autofluorescence bronchoscopy (AFB) is one of the newly developed diagnostic tools to detect the pre-cancerous lesions in the bronchial tissue. The utility of DLight/AFB in the detection of pre-cancerous lesions was compared to the standard white light bronchoscopy (WLB). In 113 patients (male 106, female 7), who visited hospital for evaluation of lung cancer, WLB and AFB were done and 364 biopsy specimens were obtained from November 2001 to August 2002. The bronchoscopic findings on WLB and AFB were compared to the pathological findings. The pathologic diagnoses of the specimens were as follows: normal in 96; hyperplasia in 69; metaplasia in 32; mild dysplasia in 13, moderate dysplasia in 6, severe dysplasia in 4; carcinoma in situ in 6; invasive carcinoma in 57. The relative sensitivity of adjunctive AFB to WLB vs. WLB alone was 1.5 in moderate dysplasia or worse lesions, and 3.2 in intraepithelial neoplasia. The specificity of adjunctive AFB and WLB alone were 0.91 and 0.5, respectively. The adjunctive AFB to the standard WLB increased the detection rate of the localized pre-invasive lesions. However, there was high rate of false positive in AFB.

Endobronchial non-Hodgkin's lymphoma.

A 23-year-old male presented with clinical and radiological features of left lung collapse. Fibre-optic bronchoscopy revealed a smooth globular mass almost completely occluding the left main bronchus. Needle aspiration and endobronchial biopsy from the mass revealed it to be a case of anaplastic large cell lymphoma, a subtype of non-Hodgkin's lymphoma. This report documents the rare presentation of non-Hodgkin's lymphoma as an endobronchial mass.

Bronchial carcinoid presenting with abdominal pain

Bronchial carcinoid tumors are very rare pulmonary neoplasms. They usually present with pulmonary symptoms or paraneoplastic syndromes. Typical [well-differentiated] tumors are usually indolent with survival exceeding 90% after resection. Atypical carcinoids have a worse prognosis. They are much more likely to recur locally or to have distant metastases. This case report describes a patient who presented with abdominal pain and hepatic lesions who was subsequently diagnosed to have bronchial carcinoid

Uveal metastasis from a bronchial carcinoid tumour.

A rare case of bronchial carcinoid tumour metastasis to the ciliary body and the choroid with clinical, diagnostic and histopathological correlation is reported.

Linfoma não-Hodgkin endobrônquico / Endobronchial involvement in non-Hodgkin's lymphoma

Os linfomas não-Hodgkin fazem parte de um grupo de doenças malignas linfoproliferativas com diferentes padrões de comportamento, de tratamento e de prognóstico. Eles podem comprometer as estruturas intratorácicas, particularmente o mediastino e o parênquima pulmonar, em alguma fase do curso da doença. Entretanto, o envolvimento endobrônquico é extremamente raro, mesmo na presença de doença avançada. Os autores relatam um caso de linfoma não-Hodgkin endobrônquico e fazem revisão da literatura.